Zawierucha Jacek, Malyszko Jolanta, Malyszko Jacek S, Prystacki Tomasz, Marcinkowski Wojciech P, Dryl-Rydzynska Teresa
Fresenius Medical Care Polska S.A, Poznan, Poland.
Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
Front Endocrinol (Lausanne). 2019 Feb 5;10:40. doi: 10.3389/fendo.2019.00040. eCollection 2019.
Secondary hyperparathyroidism (sHPT) is a common hormonal complication of chronic kidney disease. There are several therapeutic options for sHPT management aiming at calcium-phosphorus balance normalization and decrease of parathormone secretion. The aim of this retrospective, observational study was the outcome assessement of three most common therapeutic strategies of secondary hyperparathyroidism treatment with vitamin D receptor activator-paricalcitol, calcimimetic-cinacalcet or both agents administered together during in 12-months period. One hundred and thirty-one haemodialysed patients with uncontrolled parathyroid hormone secretion have been treated with paricalcitol administered intravenously (group PAR-60 patients) or cinacalcet per os (group CIN-50 patients). The last group (group PAR+CIN-21 patients) received paricalcitol i.v. and oral cinacalcet administered simultaneously. In all groups, the iPTH level decreased significantly, however in group 1 treated with paricalcitol administered intravenously iPTH level decrease was greater than in group 2 treated with cinacalcet and in group 3 treated with paricalcitol and cinacalcet in parallel. The most substantial change of iPTH level was noticed after 3-months of observation. After this period the iPTH level was stabilized and maintained till the end of observation. Safety level of all strategies was comparable. No severe hypercalcemia or hypocalcemia was observed during the whole period of observation. The results of observation show significant advantage of intravenous paricalcitol treatment. Complementing cinacalcet therapy with paricalcitol does not improve treatment outcomes. In case of unsatisfactory results after 3-months treatment, potential continuation should be considered carefully. Among three available therapeutic options, the treatment with paricalcitol i.v. should be considered in all haemodialysed patients with inadequate control of serum PTH level. The second option-with cinacalced administered orally should be considered in PD patients and when severe hypercalcemia occurs.
继发性甲状旁腺功能亢进（sHPT）是慢性肾脏病常见的激素并发症。针对sHPT的管理有多种治疗选择，旨在使钙磷平衡正常化并减少甲状旁腺激素分泌。这项回顾性观察研究的目的是评估在12个月期间，使用维生素D受体激动剂帕立骨化醇、拟钙剂西那卡塞或两种药物联合使用这三种最常见的继发性甲状旁腺功能亢进治疗策略的效果。131例甲状旁腺激素分泌未得到控制的血液透析患者接受了静脉注射帕立骨化醇治疗（PAR组，60例患者）或口服西那卡塞治疗（CIN组，50例患者）。最后一组（PAR + CIN组，21例患者）同时接受静脉注射帕立骨化醇和口服西那卡塞治疗。在所有组中，iPTH水平均显著下降，然而，静脉注射帕立骨化醇治疗的第1组iPTH水平下降幅度大于口服西那卡塞治疗的第2组以及同时使用帕立骨化醇和西那卡塞治疗的第3组。观察3个月后，iPTH水平出现了最显著的变化。在此之后，iPTH水平稳定并维持至观察结束。所有策略的安全水平相当。在整个观察期间未观察到严重高钙血症或低钙血症。观察结果显示静脉注射帕立骨化醇治疗具有显著优势。用帕立骨化醇补充西那卡塞治疗并不能改善治疗效果。如果3个月治疗后效果不理想，应谨慎考虑是否继续治疗。在三种可用的治疗选择中，对于所有血清PTH水平控制不佳的血液透析患者，应考虑静脉注射帕立骨化醇治疗。第二种选择——口服西那卡塞，应在腹膜透析患者以及发生严重高钙血症时考虑使用。
